2019 Ryan White HIV/AIDS Program CLINICAL CONFERENCE

Pre vs. Post Transplant HCV Treatment?

PanelA (LifeYears):

Red:pre-transplant treatmentyields fewer lifeyears—donot treat.

Green:pre-transplant treatmentyieldsmore lifeyears—treatnow.

PanelB: (QALYs):

Red:pre-transplantyields fewerquality-adjusted lifeyears—donot treat.

Green:pre-transplantyieldsmorequality-adjusted lifeyears—treatnow.

PanelC: (ICERS):

Red:pre-transplant treatmentyields fewer quality-adjusted lifeyears and is notcost-effective (dominated)–donot treat.

Yellow:pre-transplantprovidesmorequality-adjusted lifeyears but is not cost-effective (ICER ≥$100,000/QALY)–considerdelaying treatment.

Green:pre-transplant treatmentprovidesmorequality-adjusted lifeyears and is cost-effective (ICER<$100,000/QALY)–treatnow.

Shelton / Locke AJT 2019

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ART/DAA/IS interactions must be considered

• LDV/SOF and GLE/PIB compatible with most contemporary ART regimens and TAC based IS

• ELB/GRZ and GLE/PIB should not be given withCYA

• ELB/GRZ and GLE/PIB have no GFR restrictions

• ART should only be modified in consultation with an ID specialist

• Consultation with Hepatology is advised

Sawinski Seminars inDialysis 2019

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High Rates of Acute Rejection

HIV 31%

12.3%

StockPG,BarinB,Murphy B, et al. Outcomes from kidney transplantation inHIV-infected recipients. NEJM 2010,363:2004-14.

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